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The following is a an article published in the Spring 2014 edition of The Forum

 

The Search for a Person’s Biological Identity

By Michael Blumenfield, M.D.

 

Philomena-One of Several Films Defines The Issue

One of the top movies of 2013 is Philomena. This is the story of an elderly woman, (played magnificently by Judy Dench) who as teenager had an out of wedlock child at a convent. The movie has several interesting themes one of which is the incessant drive that a woman has to reconnect with a newborn child, which she gave up at birth. The film is based on a true story documented in a non-fiction book.

This is also a recurrent theme in several movies that I have reviewed (FilmRap.net). The Kids Are All Right, which starts Annette Benning, Julianne Moore and Mark Ruffalo, is about two lesbian parents who are raising two teenage kids who were conceived by artificial insemination with the use of a sperm donor. The film raises the possibility of what might happen if one of the children decides to track down his or her biological father. Obviously this could happen to a heterosexual couple and is an increasing possibility as new medical techniques are increasingly used to conceive and carry a pregnancy. One of the screenwriters for this film has indicated that the script was based in part on some aspects of her life.  

The Movie People Like Us with Chris Pine, Elizabeth Banks and Michelle Pfeiffer is about a man who upon the death of his father discovers that he has a 30 year old sister who he never knew about. This changed his entire understanding of his family and his own identity. The screen writing team that wrote the story also indicated that they had first hand knowledge of these issues.

Stories We Tell is a documentary film by Sarah Polley. It is about the complicated journey she has gone through as she uncovers secrets about her own family especially finding out that the man she thought was her father was really not her father. Two other very good films that I have seen in recent years that have dealt with various aspects of these themes have been Admission and Mother and Child.

Movies Mirror Real Life

These movies highlight situations that occur more often than most people realize. In situations where the man is in a relatively stable marriage, or is single and doesn’t want to get married, but is promiscuous and fathers a child, he is faced with a decision. He could acknowledge the child’s reality but choose to stay with his current relationship, or leave his original family if he is married (presumably with a divorce) and establish a family with his new child. His wife, if he was married, could make this decision for him by deciding that she would not want to live with him any more. (The second woman might not want him either.) It is possible that the father may not even know that he has created a child, as the mother of the child may not wish to tell him. The pregnant woman, of course, has to make this decision, as well as the decision whether to have the child or get an abortion.

There are also situations where a couple has a child but don’t establish a relationship and the man moves on. He then has a family at a later date and does not tell them he has fathered a child in the past. Still other variations are possible such as when a single woman becomes pregnant and gives the child up for adoption and then goes on to live her life and perhaps ultimately have a marriage and children but never mention her past history.

I am sure there are other scenarios including twins separated at birth, siblings separated at early age and not having full awareness of the other, etc. Even before the discovery of the unknown family member is made, the parent who knows the secret has the burden of keeping the secret and not being able to be truthful with people to whom they are very close, usually a spouse and children. This can lead to guilt or fantasies of what happened to the secret child. The child who only knows that his or her biological parent has abandoned him or her can never know the reason why and may incorporate fantasies involving his or her self-worth or even grandiose thoughts about being rescued by the birth parent. A story told to the child that the missing parent died will of course backfire when and if the parent appears someday and all must deal with this major piece of deception no matter how well-intentioned.

Self-Identify Founded on Life history As We know It

Our ideas of self are founded on our life history as we know it, including early childhood experiences, memories, and fantasies that are influenced by all variations and the nuances of the major players who impacted our earlier life.

There are an unlimited number of circumstances that could lead to the discovery of the unknown family members. Once a previously unknown family member is identified, the child very often has a strong desire to know about the biological parent and also meet and relate to the siblings who usually would be half siblings, sharing one parent in common.

What is the meaning of having an awareness of the existence of a biological family member who has not influenced your life for many years? What makes connecting with that person so important? Is it because you share some genetic makeup in common or that you come from some common heritage that drives the need for establishing this relationship? Is there a need to fill a void of being alone and that can be corrected by meeting someone who shares some part of you? In the case of the newly connected siblings, is it the desire to rectify the mistake of the parent(s) who were not able to construct a complete family for all their children?

Three Case Examples

I would like to present three real cases (disguised) to illustrate some of these issues. I was not the therapist for any of these people so I do not have other information about the psychodynamics.

#1. A successful attorney was married for the first time at age 35 to a 28-year woman. They had three children and a fairly close-knit family and he never had any extramarital relationships. He died at age 65 and 10 years later a 45-year man contacted the now 67-year-old widow and told the following story. This man lived in another city with his mother and he had been told that his biological father was a successful attorney with whom she had a close relationship and who had subsequently died. (In reality he left her after she became pregnant and he moved to another city.) She told her son the unusual last name of his father. He found the name easily on the Internet since he was fairly well known in his field. He never told his mother that he had information about his biological father. After his mother died, and he himself was married with an 18 year old son, he located the widow of his biological father and told her who he was. He asked permission to visit her and wanted to meet her now grown and married children and any other close family members. She agreed. She had known about her husband’s previous relationship prior to their marriage (but not about this child) and asked her children if they wanted to meet him. The oldest son was not interested but the other two agreed. An older sister of the deceased husband was not interested but her grown son was agreeable.

The younger married middle-aged children of the deceased attorney established a good relationship with the “new family member” and they would visit each other when they happened to be traveling cross country to each other’s cities for other family events. Eventually the oldest son of the deceased father found that he had certain hobbies in common with his half-brother, e.g. sports car racing and golf, and he would join in these family occasions and he began to relate to his half brother. The grandson of the older sister of the deceased man was able to help the son of the new family member get a job in the entertainment business. He and all of deceased attorney’s sibs and the widow now consider him part of their extended family. When asked why he sought out his other family, he said he felt he owed it to his son to try to give him the extended family that he never had.

#2. The new young wife of a well known sports figure died in childbirth but their infant son survived. The father was devastated and gave his son up for adoption to a distant cousin with whom he did not have any subsequent contact. The boy was brought up two loving parents. When he was a teenager he was told the name of his famous biological father who supposedly had no interest in seeing him. When this child is a grown man of 50 years old, he was in a movie theater with his wife watching a documentary about his biological father who was a legendary sports icon.

At one point in the movie the former sports figure recounted that he felt bad that many years ago he had a son whom he never met after his wife died in childbirth and he wonders what happened to him. The grown son was stunned by the interest shown in him. He contacted the filmmaker and asked if he could contact the sports icon who now lived in another country. The filmmaker agreed to arrange an all-expense-paid reunion if he could film it. The father is now a grandfather as is the son, and, after an initial meeting, the two families subsequently kept in touch with and visited each other from time to time.

#3. A teenaged mother gave her out-of-wedlock daughter up for adoption. Her daughter was raised by two loving parents. When the daughter married and had children of her own, she decided to track down her biological mother. She hired a private detective who was able to find her mother who was living alone in another city and had no other children. The daughter made contact with her, introduced her to her family, visited periodically and brought her to various family events. The oldest granddaughter became particularly close to her.

These three cases are obviously the bare facts and should raise clinical questions about the psychodynamics that are at play. What is clear is the strong need on the part of at least one person to connect with a long lost biological relative and family. There appears also to be an acceptance and probably a strong need on the part of the other family member or members to accept this contact and to learn about the lost biological family member. I believe that this area is ripe for both survey research, case reports with clinical discussion of the theoretical implications and psychodynamic and psychoanalytic theory on this subject.

 

Proposed Research Study

I would like to propose a research study to start this off which one or more of the readers may wish to organize. This would be a survey of the members of this Academy with the following questions:

1. If today you were contacted by the hospital where you were born and told that you were accidentally given to the wrong family, would you want to contact and meet your biological parents and or their families?

2. Explain your reason. What would your need be if you agreed to do this and were there any conflicts in considering this question?

3. Would you feel differently if the parents who raised you were alive or deceased? Explain.

4. How would you feel if one of your children were notified as above and subsequently made contact and established a relationship with his or her biological family?

I would hope that the self awareness and insight of the Academy members would provide a good start into understanding the questions which I tried to raise in this article. If anyone is interested in organizing this study let me know and I will put you in touch with others who are interested so a collaborative study might be developed. I will step aside from this project but will eagerly follow any developments.

________________________________________

Dr. Blumenfield is President of the Academy of Psychoanalysis and Dynamic Psychiatry. He is The Sidney E. Frank Professor Emeritus of Psychiatry and Behavioral Sciences at New York Medical College. He currently lives and practices in Los Angeles where he writes a blog PsychiatryTalk.com and also reviews movies on a blog with his wife at  FilmRap.net

Alfred M. Freedman, M.D>

Alfred M. Freedman, M.D.

DSM-II-Homosexuality1December 15th 2013 is the 40th anniversary of the historic event of “homosexuality” being removed from DSM ( Diagnostic Statistical Manual of the American Psychiatry Association )

In 2007 I interviewed Dr. Alfred M. Freedman who had been President of the American Psychiatric Association in 1973 when this event occurred. He described the details of how this resolution was passed by the APA Assembly . The interview was part of  a video podcast series which I was doing at New York Medical College. It was subsequently transcribed in the Journal of Gay & Lesbian Mental Health Volume 13 Number 1 January -March 2009 pages 62-68. The interview is available on the Internet in 5 short segments. Segments  3-5 deal mostly with this issue. In view of the historical significance of this event. I have put links to this interview below:

Interview with Dr. Freedman – Segment #1 – 6 minutes 20 seconds  http://www.youtube.com/watch?v=jhiyDAprlP4

Interview with Dr. Freedman – Segment #2 – 9 minutes 58 seconds http://www.youtube.com/watch?v=smvDA_9GJyE

Interview with Dr. Freedman – Segment #3 – 8 minutes 41 seconds http://www.youtube.com/watch?v=bmtr5kmpBus

Interview with Dr. Freedman – Segment #4 – 7 minutes 59 seconds http://www.youtube.com/watch?v=zLREZflrQrA

Interview with Dr. Freedman – Segment #5 – 4 minutes 24 seconds http://www.youtube.com/watch?v=z5YsWT48lEE

For more information about Dr. Freedman see an earlier blog .

 

Michael Blumenfield, M.D.

mblumenfield@aol.com

 

 

 

9780307718969_custom-c5e860538756bdf498808fb3144c77d4a46dce7f-s6-c305 Days at Memorial: Life and Death in a Storm Ravaged Hospital by Sheri Fink – This is a great book for anyone who works in a hospital especially doctors and nurses who realize they could be on call when a disaster might strike. Also include yourself in this group if you are a  hospital administrator or someone who likes to wrestle with ethical dilemmas. Be prepared for a lot of repetition, medical details that may all seem to be almost the same to most people as well as for some dips into the history of this hospital, other disasters and a course in ethics over the years even dating back to ancient times. If you can handle all of this, you really have an exciting, intellectually stimulating book with a look at disaster medicine, making medical and ethical decisions under difficult circumstances and some good legal battles. The main event was the 2005 Hurricane Katrina, which was the costliest natural disaster, as well as one of the five deadliest hurricanes in the history of the United States. At least 1,833 people died in the hurricane and subsequent floods. This book deals with the impact of the storm on Memorial Hospital in New Orleans, which was a 312-bed hospital, which included patients receiving intensive care and a larger section of the hospital where critically ill patients were treated. As the floodwater rose, most of the power in the hospital was irretrievably lost. There was no sanitation, and they were running out of food. Indoor temperatures were as high as 110 F degrees. At one point there were over 2000 people in the hospital as the numbers swelled with families of patients and staff as well as refugees from the surrounding city. The hospital became surrounded by water and there was no way to leave by car. A makeshift helipad was established on the roof but to get there patients, had to be carried up several flights of stairs usually in the dark and passed through a hole in the wall to get to another part of the hospital complex and up additional stairs. There was limited oxygen for these patients and for some the nurses had to squeeze a balloon like device to get the air into their lungs and drip an IV into their veins while going up the stairs. It was difficult getting enough helicopters to remove all the people from the hospital. Decisions had to be made which patients to evacuate first. Should it be the ones that were barely alive and wouldn’t be expected to even survive the trip to another location or perhaps already had a fatal illness where their demise was expected in a few days or should the patients go first who had a better long term outlook but still required hospital care?? Should the preference or order of care be influenced if the patient had a DNR order, meaning do not resuscitate the patient if their heart stops or if they stop breathing. As the first three or four days passed most of the people were evacuated (where they were evacuated to was another problem). There was confusion and questions about the actions by the corporation that owned the hospital and what arrangements they were making to help the stranded hospital’s need for evacuation. Outside the hospital gunshots were heard and there were concerns that looters might enter the hospital by boat. There was a concern about the physical integrity of the old hospital walls. You would think that the National Guard and the US Government should have done a heroic operation to save everyone from the beginning. They apparently were saving people from rooftops of their homes, helping out in the Superdome, which was the place of last resort for the people of New Orleans who weren’t able to escape before the flood, as well as sporadically appearing on the helicopter pad.  In the end there were a small number of doctors and nurses trying to care for the remaining and sickest patients. There was concern that even moving some of them would be fatal. One man was so obese that they couldn’t figure out how to move him. Some patients were clearly in the last hours hours of their lives. Others would soon be that way if they didn’t get more intensive care. One of the remaining doctors along with two nurses was Dr. Anna Pous, a very compassionate and brilliant ENT surgeon who had a history of reconstructing patients with advanced cancer. She found herself faced with the task of trying to relieve the suffering of several remaining patients. It is well known to physicians and nurses who treat dying patients, that morphine often in combination with a rapid acting tranquillizer such as Versed, given intravenously will relieve the pain and agonizing difficulty breathing in the final stages of life. It is also known that this treatment could hasten their demise. Dr. Pous appeared to made the  decision to have several patients receive large doses of morphine and Versed which would peacefully end their lives. At a later point in time this was felt by some people to be murder. In fact, Dr. Pous  was actually arrested, handcuffed and was with two nurses charged with second-degree murder. The response of the medical community from this hospital and from across the country, the legal and emotional reactions of some of the patient’s families, the media hype and the ethical questions which were being asked, were an important part of this book. The book provides few answers and lots of stimulating questions. The author won a Pulitzer Prize for her reporting on this subject in the New York Times Magazine. If you are drawn to this subject you will not be disappointed. 

 

Ido in Autismland by Ido KedarIdo_in_Autismland_Cover_for_Kindle

Although I am not an expert in this area, I believe that this will be a landmark book for families, educators and any professionals who work with young people with autism. It is a book of short essays written by a 15 year old about his experience with his condition starting with some pieces written when he was 12 years old.

What is unusual, unique and very important about this author is that he cannot speak and only when he was about 11 years old did he begin to communicate by pointing to letters on a letter board. Up to that point no one had any idea that he was an above average intelligent kid who began to read when he was about three years old. He was terribly frustrated by being treated by well meaning experts in autism and education by drilling him on simple exercises meant for a three year old child who was having trouble learning. He was asked to point to his nose which he often could not do and was judged accordingly.  Even when he began to point to letters and make intelligent sentences, just about everyone thought that his mother was guiding his hand since she had to steady it for him to point. It took his father, who is a scientist, two more years before he was convinced that his son was truly communicating fully formed intelligent sentences. The problem would seem to be that he could not control his body. He often would have great difficulty even signaling that he could make even  simple calculations or understood basic concepts.  This was further complicated by his arm flapping which would occur when he was anxious which he referred to as “stims” . Other times he would do unexplainable pieces of behavior such as pulling his Mom’s hair or that of beloved aide when he was frustrated or embarrassed. This pattern of behavior is common in many children who fall under the rubric of autism except they are usually not recognized to understand things and mainly have trouble in controlling their bodies to communicate. Instead they are often deemed “retarded” and/or  “developmentally handicapped.”

Ido believes that he is not “one in a million” and that he has had indication that many of his friends with non verbal autism are as frustrated as he used to be. Once Ido proved he could communicate with a letter board and then on the keys of a computer, a new world opened up to him. He was put in mainstream classes which he would attend with an aide and has entered high school with the aspiration to go to college. It is a constant uphill battle, as while the administrators of his middle school were very supportive, he found that was not the case of the first high school which he entered. Obviously, it did takes a great deal of resources and some special accommodation to allow him to function in a regular high school environment. After transferring to a second high school he seemed to be quite adjusted as he continues forth.

This book traces his progress as well as clarifying many of his characteristics and experiences. For example he sees people in different colors such as red blue, yellow etc. which are related to their emotional state perhaps in relationship to himself. He is also very sensitive to sound and appears to have very keen hearing . He therefore at times gets overwhelmed by loud noises, certain music. being in the presence of multiple people talking . These and other situations can cause him to have what would appear to be overwhelming panic attacks. This is not only experienced as severe anxiety but it intensifies uncontrolled movements of his body. Over the years he has found that various types of physical training and exercise actually improved his self control, something that was not initially recognized as it was neglected in any attempts to assist him.

I found it interesting, as a psychiatrist,  that he did not mention whether or not he was given a trial on any anti-anxiety and anti-panic medications which are believed to directly  effect various pathways in the brain which are involved when people have such overwhelming emotions. I would imagine that the medical experts in this field have evaluated the  effect of such drugs as an adjunct to his treatment program but if they have not, it certainly should be done.

Ido frequently mentions that he knows that he has an illness that places many limitations on him but he prefers to focus on what he can do and what he hopes to be able to do in the future. He also is dedicated to teaching the public as well as families of children with autism and experts about the potential of people like himself.   Ido would probably say “so called experts” since he has a sense of humor and he is keenly aware of how so many experts have misinterpreted his abilities). Not only is he becoming an advocate but he must be also considered to be a hero for so many people who are locked in the land of autism. 

For a view of brief video clip of Ido at a meeting as one of his speeches is read go to:  http://www.youtube.com/watch?v=V4VR1KYRX8s

 (This book can be purchased through AMAZON by clicking the AMAZON link in the right hand column)

 

Dr-Abraham-Halpern150My friend and colleague Abe Halpern passed away on April 20, 2013. Abe was a remarkable and unforgettable person. He was a loving and dedicated husband, father, grandfather and and great grandfather.  He also was a skilled forensic psychiatrist and an activist for many the causes in which he deeply cared about.

Abe and I belonged to the same District Branch (Westchester Psychiatric Society) of the American Psychiatric Association and were both on the faculty of New York Medical College in Valhalla, New York, so I had numerous opportunities to see him in action. I also observed him stand up for his beliefs at the Assembly of the American Psychiatric Association where he introduced various resolutions which were passed due to his persuasive advocacy. He was a reader of this blog and was kind enough to frequently make constructive suggestions to me.

 

I had the opportunity to sit and down  and conduct a one to one  recorded interview with Abe where he discussed three topics which were dear to his heart. This interview is presented below in three parts:

Halpern

Part One  – Is there a role for a psychiatrist in the care of a prisoner who is being executed?

Part Two – Is there a role for a psychiatrist in the questioning of a prisoner?

Part Three – Should Marijuana be legalized ?

 

 

Born 2/2/1925. Died 4/20/2013 as a result of an earlier fall. His family emigrated to Canada in 1927. As a teenager, he joined the Royal Canadian Navy serving in both the Atlantic and Pacific theaters during WWII. After the Korean War, he was honorably discharged at the rank of Lieutenant Surgeon Commander. A medical school graduate of the University of Toronto, he practiced psychiatry for over 50 years and was a leader in the subspecialty of forensic psychiatry. Awards from the American Medical Association, American Psychiatric Association, and from many other organizations of medicine reflect a life dedicated to human rights. He marched with Martin Luther King, Jr. in Selma, fought against China’s torture of the Falun Gong and illegal organ transplantation, the misuse of the insanity defense, and forced psychiatric hospitalization without judicial review. He was a national and international leader against the involvement of physicians in capital punishment and also physician participation in coerced interrogations of prisoners. All were subject of his prolific publications. He is survived by his beloved wife Marilyn, and his loved children (and spouses) Howard, Lon (Barbara), Marnen (Herdis), Chaia (Adam), Mark (Tomoko), Emily, and John. He was an adoring grandfather of 11 and great-grandfather of 5.

 

On May 20th 2013 the Social Psychiatry Committee of the APA awarded Abe Halpern the Humanitarian Award. John Halpern accepted the award on behalf of his father. In the future this award will be named the Abe Halpern Humanitarian Award. Click here to see John’s tribute to his dad on that day

 

 

 

 

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